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Believe it or Not

Here is a great story that Dr. Weinberger just had published in Senior Bulletin which is published by the Senior Members of the American Academy of Pediatrics (AAP)

Believe It or Not Miles Weinberger, MD, FAAP

This is not Ripley’s, but the personal experience of a physician. My first memory of this unusual clinical problem was a boy, about age 10, admitted to the hospital when I was a resident. He wasn’t my patient, but a loud barking cough could be heard by all from his room at the end of the hall. The astute chief resident announced that the cough was functional in that there was no organic basis for the cough. I don’t remember the outcome of that boy, but fast forward past two years at the National Institutes of Health, two years in fellowship at the National Jewish Hospital, to private practice in Marin County California. I remember a 9-year-old girl brought to my office by both parents, who described that she had been coughing all day for several weeks. I recognized the pattern of coughing as unlikely to have a physical cause. Like other physicians before me, I used a behavioral technique and stopped her cough within 15 minutes. I saw her a week later with psychogenic polyuria-polydipsia. I advised how to stop that, but she returned a week later with psychogenic polyphagia. I recognized that her problem exceeded my skills and referred her for psychiatric evaluation. Fortunately, during the next 45 years of practice, I never had another case exactly like that.

However, functional cough, a chronic cough without a cause, was a recurring problem at the allergy and pulmonary clinic I began in 1975 at the University of Iowa. Based on a 1966 publication by Boston allergist Dr. Bernard Berman, the diagnostic term for that clinically characteristic functional cough was “habit cough”. The cough was readily recognized by the frequent barking cough heard even from the waiting room. Eventually, an average of 9 children per year were seen at our clinic with that unique cough. The cough frequently occurred several times per minute during all waking hours, only absent once asleep. The average age of children seen in the clinic for habit cough was 10 years with a range from 4 to 18 years. The prior duration of this type of cough in those children was a median of 4 months. Of 140 children with habit cough, 18% were described as having daily cough for over a year. Dr. Berman described successful treatment by “the art of suggestion.” Ergo, we called the simple behavioral technique successfully used at the University of Iowa Clinic, “suggestion therapy”. That’s a good story, but there’s more. I retired from the University of Iowa in February 2016. In February 2019, I received a phone call from the father of a 12-year-old girl with daily coughing repeatedly for 3 months. He had seen my previous publications on the subject, concluded his daughter had the same problem, and asked for help. Although never previously done, I successfully used suggestion therapy remotely via teleconference. Her father recorded the 30-minute session. Amazed and delighted that his daughter stopped coughing, he placed the recording on his website. So, routine use of suggestion therapy during a clinic visit to stop prolonged coughing was effective with patient contact and also remotely by teleconference. But the story gets better and approaches “believe it or not” status. Unexpectedly and unintended, we began receiving reports of habit cough cessation from parents when their child with habit cough viewed the video on the web. No physician contact was involved in cessation of cough. This successful suggestion therapy by proxy was eventually reported over a hundred times in the US and 15 other countries. Parents and adults from multiple countries providing unsolicited reports that watching a video recording stopped months of coughing is a “believe it or not” experience. The personal and family suffering of daily coughing for months or even years perhaps must be seen to appreciate the disturbing quality of life experienced by those with chronic cough. Those with habit cough further suffer frequently also from unsuccessful iatrogenic efforts to treat the cough, which responds to no pharmacologic agent. To transpose a famous Sherlock Holmes statement, when you have eliminated all possibilities, the unlikely becomes likely. Cessation of a chronic cough, present for months or years, by watching a physician talk by teleconference recording to a 12-year-old girl and stop her cough, seems unlikely and incredulous, but it happens, believe it or not!



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